Provider Demographics
NPI:1497965057
Name:GULBRANSON, SHANNON RENAE (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:RENAE
Last Name:GULBRANSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:RENAE
Other - Last Name:SUBRAMANIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1335 E 11TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4634
Mailing Address - Country:US
Mailing Address - Phone:918-500-4452
Mailing Address - Fax:
Practice Address - Street 1:1335 E 11TH ST STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4634
Practice Address - Country:US
Practice Address - Phone:918-005-4452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor